224 1/2 CANAL STREET - BUILDING JACKET //7/Y/lU'l6G1-4
UPC 10333
No. 153L-3 gaz
HASTINGS. OON
PATRICK J. DONOVAN ASSOCIATES, INC..
claim and ells Adjustments
P. 0. BOR 110
WAKEFIELD, MA 01880
TEL. (781) 245.5540 — FAX (781) 245-7016
June 25, 2001
Building Commissioner
City or Town Hall
Salem, MA 01970
Insured : Jamesd J & Ann J McDonnell
Property Address : 224 1/2 Canal Street, Salem
Insurer : Providence Mutual Insurance Company
Policy Number : H000000047110
Type of Loss : Water Damage
Date of Loss : 6/24/01
Our File # : WAP32583
Claim has been made involving loss, damage or destruction of the above-captioned
property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143,
Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section
3B is appropriate, please direct it to the attention of the writer and include a reference to
the captioned Insured, location, policy number, date of loss and file number.
On this date, I caused copies of this notice to be sent to the persons named above at
the addresses indicated above by first class mail.
uss Williams, Adjuster
RW/so
ASSg 11,1101 OF INDEPENDENT INSURANCE ADMERS
�y of Massachusetts
d� s,o